Enigma

Throughout the symptoms of this disease, there is something so peculiar to itself, that no description, however accurate it may be, can convey to the reader a proper idea of its nature.

— Thomas Trotter, Observations on the Scurvy (1792)

In Daniel Defoe's Journal of the Plague Year (1722), the calamity of the arrival of bubonic plague in London in 1665 is sharpened considerably by the ignorance of everyone in the city concerning the cause of the disease, its mode of transmission, the fatal tendency of its symptoms, and the method of its cure. While generally it is assumed that it arrived in a cargo from the East, nobody knows where it was lodged, whether in fabric, ointments, or food, nor how it was at first communicated, whether by touch, effluvium, or the hand of God. The cures attempted range from the probable (fumigation) to the superstitious (amulets). The symptoms vary, and the progress of the disease is uncertain. People who have been in close touch with victims survive, the afflicted who have been isolated succumb; some die as soon as the marks are on them, others recover if the swellings burst. Although the narrator seems powerfully of the opinion that shutting up stricken houses with the survivors still inside is the only way to contain the infection, he is full of praise for those who evade municipal controls by getting out of the window, or blowing up the watchmen, or escaping to the country, or by supporting their diseased families with the income from ferrying passengers, freight, and possibly the plague itself up and down the river. Every attempt made by the narrator to nail an effect to a cause or a problem to a solution is inevitably contradicted by events or his own judgments, leaving him confronting unrelated events that coalesce into a kind of miracle: "A dreadful plague in London was / In the year of sixty-five, / Which swept an hundred thousand souls / Away, yet I alive!" (Defoe 1966: 256).

His narrative explodes into a montage of astonishing scenes — a naked man walking down the street with a pan of burning coals on his head; another mistaken for a corpse and making a joke of it as he climbs out of a death pit at Mount Mill; grass growing in the streets; eldritch shrieks of the dying and bereaved. He is unable to trace a sequence leading to any predictable outcome. The plague haunts everything, because although everyone knows what it does, nobody knows what it is; and the result is a confusion that involves both the event and every effort to make sense of it. "Here was no difference made," says the narrator of the Mount Mill pit, where corpses are tumbled in regardless of age, sex, and nakedness, whether they are quick or dead, advertising a chaos in which all distinctions are lost — between the living and the dead, the poor and the rich, the decent and the shameful, the effectual and the ineffectual, belief and horror (80). Doubtless Defoe's decision to pass off his fiction as history was influenced by the consideration that amidst such sheer confusion the difference between what is imagined and what is true is immaterial and that fidelity to such a prodigious interruption of civil life requires more than facts to do it justice.

The modern reader of H. F.'s narrative is placed in a position rather like that of the female spectator who shouted out to Othello that he was a fool for not believing Desdemona innocent. For the reader is perfectly acquainted with the truth; namely that bubonic plague is incubated and transmitted by the fleas that live on rats; or, in the case of the pneumonic variant, by the breath of the victims. But the fascination and tension of this historical moment arises from the fact that those in peril did not know this and had no hope of knowing it. We observe how epidemiology is transformed into something like fate, and acts of self-preservation into dramatic irony. We assume for the purpose of intelligent inspection of any epidemic that there is a methodical relation between the empirical facts of the disease and the biochemical breakthrough that will put an end to its dominion. We assume further that the lapse of time is a series that can be understood and that the structure of a historical situation depends on an orderly adjustment of the inside of private experience to the outside of public knowledge. But those in the midst of the infection in 1665 reacted to it as an apocalypse from which the differences between past and future, and between an interior space and an external point of observation, had been obliterated. And it is to that dreadful intuition of lost coordinates that H. F. is loyal, rather than to the reader's medical hindsight or faith in providence. He calls the plague a "speaking sight" because it communicates only with those implicated in it, not to readers of subsequent accounts of it. "It is impossible," he says, "to say anything that is able to give a true idea of it to those who did not see it, other than this, that it was indeed very, very, very dreadful, and such as no tongue can express" (80, 79). Time and space puzzle him. He has no explanation for how the affliction began or how it ended; why it traveled where it did and why it stopped when it did. He is equally confused about social policy and personal resourcefulness in this kind of emergency, whether quarantine or escape is the best plan, or whether resignation is not, in the end, the only feasible response.

Over a much longer span of time and on a much broader canvas, scurvy exhibited the same dramatic overthrow of the structure of meaning on which its students and victims wanted to rely. Even though it had been known from the first that food played a part in the onset and the cure of this disease, the identification of a preventive in fresh vegetables, meat, and fruit, and of a remedy in concentrated citrus juice (called "rob"), was never universally embraced or systematically pursued. Although victims were regularly restored to health, provided they could make land and start eating the herbs and salads they found growing there, disagreements among medical experts about the causes and treatment of the malady, combined with clinically uncertain results from remedies used at sea, inclined them to rely on favorite theories rather than experiments because facts simply compounded the confusion. Close observation of symptoms yielded "a strange jumble," Sir Gilbert Blane complained, where no one datum was consistent with another (Lloyd and Coulter 1961: 3.298). Thomas Willis spoke for many subsequent physicians when he called it, "an Iliad of Diseases": "It extends itself into so various and manifold Symptoms, that it can neither be comprehended by one definition, or scarce by a singular description" (Willis 1684: 170, 169). "The Scurvy," wrote Sir Everard Maynwaringe, "owns not one univocal cause, but is the Bastard of many Parents" (Maynwaringe 1666: 5). Thomas Trotter was by no means the only one to notice that scorbutic symptoms were as likely to multiply in the head as the body, with a repertoire of temperamental peculiarities that added to the difficulty of making an adequate diagnosis. Thomas Beale, a victim of the disease, announced the difficulties of comprehending an illness that overflowed all points of observation and resistance: "Our mental sufferings were such as defy description, and nothing but being placed within the same situation could convince those who have not the power to imagine its monotonous dreariness" (Beale 1839: 310). Like Defoe's narration of the plague and like Shakespeare's dramatization of the extravagances of jealousy, a gulf divides those absorbed by pain and passion, and those who are not. If the latter were able to apprehend the full extent of scorbutic dreariness, then they would know the eyewitness speaks truly of it; but as this is impossible, they cannot even form a judgment of what it was like.

The history of scurvy is heavily marked by this conflict of interests between those who dwell inside the drama and those who don't. The biochemical breakthrough that isolated ascorbic acid and explained its physiological and neurological importance to the human organism was never aligned with the history of empirical knowledge of the disease. That is to say, biochemistry and naval medicine never shared an inevitable and common destination, although there were many occasions when a coalition of the two was accidentally and briefly achieved. But it will be evident in the course of this chapter that it is difficult for anyone outside the disorganized and passionate situation of scurvy itself not to consider its history as anything but periodic fits of willful ignorance that blinded the world to a necessary truth and an obvious cure: a dismal record then of lost opportunities and culpable amnesias. And in proportion, as the desire to understand the disease from the perspective of its allegedly final elucidation inflects the account of it, another angle of it is ignored. This is the history of immethodical passion, variously productive of misery, exhilaration, mistakes, madness, heroism, and death — the sort of history H. F. writes of the plague and that the lady in the audience thought Othello might coolly have sidestepped, had he only known the truth.

Perhaps in an effort to redress the balance, it has been common in recent years to sound a triumphal note when mentioning the clinical trials of James Lind aboard the Salisbury in 1747 and James Cook's conquest of scurvy during his Pacific voyages. The bearing of Lind's work on the practical successes of Cook in avoiding fatal outbreaks during his decade of navigating the South Seas (1768–79), and the navy's later decision to distribute rations of lemon juice to all sailors, are greeted as phases of a real and solid progress in eradicating the affliction, thus the title of Francis E. Cuppage's book, James Cook and the Conquest of Scurvy (1994). The subtitle of a history of the disease, How a Surgeon, a Mariner and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail (Bown 2003), is intended as triple homage to the experimental breakthrough of Lind, the prophylactic successes of Cook, and the administrative genius of Sir Gilbert Blane, each praised for discovering and applying the virtues of antiscorbutic remedies and regimes broadly enough to keep the British Navy in fighting trim throughout the Napoleonic Wars.

The truth is that these men achieved much in their respective fields, but none provided an unequivocal solution to the problem of scurvy. Lind had empirical evidence to show that citrus juice removed its effects, but he was much more hesitant in adducing causes, suggesting that indigestion, blocked pores, and the weather might be factors as malign as the shortage of good food. His specialty was cure, not prevention, and even then he was cautious, warning toward the end of his career that health at sea could not demonstrably "be ascribed to any diet, medicine, or regimen whatever" (quoted in Carpenter 1986: 70). In their survey of medicine and the navy in the eighteenth century, Christopher Lloyd and Jack Coulter have suggested that Cook's neglect of lemon juice in favor of malt wort, which then gained his powerful endorsement in a paper he gave before the Royal Society in 1776, set the cause of citrus back for a generation (Lloyd and Coulter 1961: 3.302). For reasons which must have had more to do with naval economies and medical politics than clinical accuracy, malt (valueless as an antiscorbutic) became the chief official remedy for thirty years, relied on by many surgeons afterward, thanks largely to Cook, whose banishment of scurvy from his ships (particularly the Endeavour) lent practical authority to his judgment in its favor. As for Gilbert Blane, his espousal of the cause of preserved lemon juice was to result in something like its general distribution as a preventive in the navy from the mid-1790s; but he was candid enough to admit that the efficacy of the concentrated juice was not guaranteed, being significantly less than that of fresh lemons, probably owing to the method of preparation (3.132, 319–21). Although Blane arranged a repeat of the success of Lind's clinical trial aboard the Suffolk in 1793, which sailed to Madras without a single case of scurvy, his preference was always for the fresh juice rather than the rob, a position consistent with his insistence on nutrition as the major factor in the cause and cure of scurvy, one that was shared by the other chief proponents of citrus, such as Thomas Trotter and Nathanael Hulme, although with rather different emphases. On the night before Trafalgar, Admiral Nelson penned a note on the importance of the supplies of onions held on his ships, which, after three months at sea, formed his most reliable stock of antiscorbutic food (Times, 3 May 2013, 3).

If we are looking for a hero in the history of scurvy, Lind would certainly be a leading candidate had the Admiralty not entirely neglected his achievements for forty years, and had his own eclectic approach not misled him. In the context of a disease so manifold and inconstant, perhaps it is inevitable that the person who comes closest to the heart of its mystery is ignored, especially if his discoveries are empirically and not epidemiologically produced. Any empirical cure has to compete with all the other practical and theoretical remedies in which so many people, some of them powerful, have an interest. Not until Albrecht Szent-Gyorgyi isolated the antioxidant molecule he called hexuronic acid, which he found in high concentrations in the adrenal cortex, and which Charles Glen King and A. W. Waugh subsequently found in lemon juice, was the indisputable cause of scurvy known to lie in the depletion of vitamin C, or ascorbic acid (Carpenter 1986: 186–90). Previously, it was referred to variously as a charm, a je ne scais quoi, a sap, a miasma, or a taint in food that entered the body and corrupted it. And because of the obscurity of the cause, Lind was seduced into theories that lessened the value of the results of his clinical experiment on the Salisbury. Another ignored hero in the history of scurvy is Hugh Platt, a contemporary of Francis Drake and Richard Hawkins, who seemed to have understood a lot earlier than most that there is a virtue in citrus that is at its maximum when fresh and requires careful processing and storage if it is to be preserved in any useful quantity. His "philosophical fire" seems to have been a method of pasteurizing juice to prevent fermentation while preserving its curative content. Furthermore, he had devised a method of airtight bottling that likewise kept the juice free from contamination and decay. But as no one was willing to pay for this secret, the secret was kept until Nathaniel Hulme borrowed it for Sir Joseph Banks (Keevil 1957: 1.107–9). Platt knew that it was one thing to find out that fresh oranges, lemons, and limes would cure the scurvy, but quite another to ensure that their hidden virtue lasted over distance and time.

The handkerchief in the Othello tragedy of scurvy is citrus juice. In the play, the embroidered fabric circulates as an equivocal sign of innocence, and at sea, the juice acts fitfully as a lesson in antiscorbutic medicine that is no sooner learned than it is misused, mistaken, or forgotten. Neither ever coheres into a satisfying and final proof of worth and virtue. Favored by the British and eventually the Americans, but never much fancied by the Dutch, French, Spanish, or Russians, citrus juice makes many appearances that are decisive and elusive by turns (Keevil 1957: 1.223). From the earliest days of long-distance navigation the medicinal value of oranges and lemons was known and exploited. Richard Hawkins and James Lancaster had used them and vigorously recommended them. John Woodall endorsed the antiscorbutic benefits of citrus in his influential book on maritime health, The Surgeon's Mate (1617). Long before Cook, Drake managed a voyage of a thousand with only a single victim of scurvy. The regimes pursued by these mariners were very like Cook's, for besides the use of fruit and fresh greens, they all appreciated the importance of having a clean and dry ship, a well-clothed crew, and frequent stops for refreshment. One of the reasons for the Admirality's neglect of Lind was the embrace it extended to broad-spectrum prevention (of which he himself was a proponent) evident in the wide variety of dietary supplements supplied by the Sick and Hurt Board to John Byron, Samuel Wallis, Philip Carteret, and Cook in their explorations of the Pacific during the 1760s.

Before David MacBride published a theoretical account of scurvy that claimed for malt the curative potency Lind had found in oranges and lemons, it was commonly understood that a variety of precautions and remedies would defeat scurvy, not a single wonder cure. This was basically Cook's approach, until he was edged into a public recommendation of malt after he returned from his second Pacific voyage. Lind himself had never proposed the juice of oranges and lemons as a superlative remedy, only rather more effective than other medicines, such as electuaries, malt, vinegar, and vitriol. This was a fact he had experimentally disclosed, not a program of general health he espoused. Therefore it was not he, but physicians such as Gilbert Blane, Nathaniel Hulme, and Thomas Trotter who recommended lemon or lime juice as an invaluable resource for the navy. And even they had reservations — Blane about the quality of rob at sea, Trotter about the effect of frequent doses of acidic liquid on the stomachs of seamen, while Hulme was aware that the preparation of reliable rob was elaborate and expensive.